Fantasy Football - Registration

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Customized NFL Jersey
Customized NFL Hat
Helmet from favorite team
Jacket/hoodie from favorite team
Beanie from favorite team

Other NFL gear from favorite team
Gift card to Champs Sports
Footballs
BGC swag
And much more

League Registration

General:

* Indicates required field

Child's Full Name *

Is the child a previous Club member? *

Child's Date of Birth (MM/DD/YYYY) *

Child's Age *

Child's Gender *

Child's Shirt/Jersey Size *

Child's Home Address *

Line 1

Line 2

City

State

Zip Code

Country

List name, telephone number, and email address where parent/guardian may be reached while youth is under BGCCB supervision.

Parent 1/Guardian Name *

First

Last

Parent 1/Guardian Telephone No. *

Parent 1/Guardian Email Address *

Parent 2/Guardian Name *

First

Last

Parent 2/Guardian Telephone No. *

Parent 2/Guardian Email Address *

Emergency:

List name, telephone number, and relationship to a responsible individual that can be contacted in the event of an emergency when parent/guardian can not be reached.

Emergency Contact Name *

First

Last

Emergency Contact Telephone No. *

Emergency Contacts Relationship with Individual *

I grant permission to managing personnel or other representatives to authorize and obtain medical care from any licensed physician, hospital or medical clinic should a participant become ill or injured while participating in activities away from home, or at any other times when neither parent is available to grant authorization for emergency treatment.

Electronic Signature (Emergency Medical Attention) *

First

Last

Date (MM/DD/YYYY) *

Authorization:

I give my permission for my son/daughter, (names above), to participate in the Boys & Girls Clubs of the Coastal Bend 2022 Fantasy Football League.

I have read and understand the rules and expectations of the Boys & Girls Clubs of the Coastal Bend 2022 Fantasy Football League.
- Fantasy Football - Rules

I understand that although my son/daughter will be supervised by the Boys and Girls Clubs of the Coastal Bend (BGCCB) staff member(s), I do assume the risk in my child’s participation in the event/field trip. I acknowledge that I will not seek to have the BGCCB held liable in the event that any accident, injury, loss of property or any other circumstance or incident occurs during or as a result of my son’s/daughter’s participation in the event/field trip. I hereby release and agree to hold harmless the BGCCB, its administrators, managers, staff members, and participants from any claims arising out of my son’s/daughter’s participation in this league.

Electronic Signature (Authorization) *

First

Last

Date (MM/DD/YYYY) *

I hereby grant full permission to any and all of the forgoing to use any photograph, video tapes, motion picture, recordings or any other record of this event for any legitimate purpose.

Electronic Signature (Media Release) *

First

Last

Date (MM/DD/YYYY) *

COVID-19:

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

Boys & Girls Clubs of The Coastal Bend, Inc. (Club) has put in place preventative measures to reduce the spread of COVID-19; however, the Club cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Club could increase your risk and your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the Club and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Club or participation in Club programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Club, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.

Electronic Signature (COVID-19 ) *

Date (MM/DD/YYYY) *

Acknowledgement:

I have read and understand and accept all of the statements recited above and accept full responsibility as described.

Electronic Signature (Acknowledgment) *

First

Last

Date (MM/DD/YYYY) *

Submit

For league details or information, please contact:
Rick Avila, Teen Coordinator
3902 Greenwood Drive, Corpus Christi, Texas 78416
E: ravila@bgccb.org | T: 361-853-2505

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League Registration

General:

Emergency:

Authorization:

COVID-19:

Acknowledgement:

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